The subject of scruples was very thoroughly worked out and carefully described by the older spiritual writers centuries ago. They wrote elaborate treatises on it, while it was not until our own time that physicians by their careful study of corresponding conditions entirely apart from religion came to appreciate that these conditions of the spiritual life were only expressions of a rather common set of tendencies altogether independent of religion. They are prone to develop in people with certain physical and mental characteristics who are possessed of dispositions and nervous systems particularly likely to be the subject of these hesitancies and doubts and difficulties for which there is very little basis in actuality. The whole chapter of phobias and the other chapter on obsessions and the third on what the French call _la folie du doute_, the doubting mania in our modern textbooks of neurology, are really so many chapters in the {221} literature of scruples of the old time, now transferred to the textbooks on functional nervous diseases. Some nervous people who are religiously inclined get into a very disturbed state of mind from the fear that they may commit sin almost unknown to themselves or that they may be in sin unawaredly and cut off from their Creator, and they become extremely miserable as a consequence. This is, after all, a very familiar picture to the neurologist accustomed to see patients suffering from functional nervous diseases. I have patients who suffer quite as much from the dread of dirt as these scrupulous people do from the dread of sin. Women often suffer from this dread of dirt--misophobia is the scientific name derived from the Greek--to an exaggerated degree. A woman patient of mine makes it extremely uncomfortable for the conductors on the street cars because, for fear of contaminating her hands, she dreads to touch the handle bars by which she could mount or descend easily. This adds greatly to the risks she takes every time she boards a car. She is constantly washing her hands to get the dirt off, so that in cold weather she sets up severe skin irritations and makes herself very uncomfortable. I have a male patient who would not touch the handle of my door for the world, and whom successive maids have come to know very well because he stands outside the outer door and has to have that as well as the inner door opened for him. He has said to me over and over again, "Doctor, don't ask me to shake hands with you, because you shake hands with so many people." I have seen him standing outside of a large department store with the temperature around zero, waiting for some one to open the door so that he might slip in without touching it. Nor are such states {222} of mind confined to the uneducated; on the contrary, they are commonest among those who have a good education and are quite sensible in other things.